Mr Andrew Lale Consultant ENT surgeon

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Presentation transcript:

Mr Andrew Lale Consultant ENT surgeon DYSPHAGIA Mr Andrew Lale Consultant ENT surgeon

SWALLOWING “5 minute consultation” CAUSES: Acute Neurogenic Globus pharyngeus Laryngopharyngeal reflux Strictures and narrowing Pharyngeal Pouches

CONSULTATION True Dysphagia or feeling of a lump? Dysphagia for what? Regurgitation or Aspiration? Gastro-oesophageal reflux current or past? Change of Diet or weight loss? Odynophagia

ACUTE DYSPHAGIA History: FB. Previous problems. Examination: Drooling. Pain. Pyrexia. Odynophagia Treatment: Food bolus: Buscopan, fizzy drink, refer at 1 hour FB: Refer

Foreign bodies

Strictures and narrowing Malignant/benign Cricopharyngeal bar C-spine osteophytes Kyphosis Post cricoid web

Cricopharyngeal bar

Osteophytes

Neurogenic CVA Motor neurone disease Multiple Sclerosis Parkinson’s disease Myaesthena gravis

GLOBUS PHARYGEUS Previously Globus Hystericus Worse when NOT eating or drinking No true dysphagia solids/liquids No odynophagia No reguritation/aspiration Variable history. ?exclude reflux…..

Laryngopharyngeal Reflux (LPR) Reflux of gastric acid to larynx/pharynx May be “silent” Symptoms include feeling of a lump, odynophagia/chronic sore throat, chronic cough (especially nightime), hoarse voice and “mucous in throat”.

LPR Investigations Nasopharyngoscopy, red post cricoid region. ? Barium swallow? Oesophageal pH manometry

LPR treatment 6 weeks PPI + Gaviscon initially At review further 6 weeks treatment if improving General laryngeal hygiene measures If no better, rigid pharyngo-oesophagoscopy pH manometry ?fundoplication

Pharyngeal pouches HISTORY Long Hx dysphagia Regurgitation esp at night “gurgling” swallow Aspiration (recurrent pneumonia) Weight loss and change in Diet.

Pharyngeal Pouches EXAMINATION Nasopharyngoscopy might show pooling Unlikely to feel anything in neck Barium swallow

Pharyngeal pouches TREATMENT Surgical if fit for GA (External approach) Endoscopic stapling, low morbidity and high success rate.

Pouches

Pouches

Summary :Fast track patients Young male patient Short history Odynophagia Smoking and Alcohol Weight loss Aspiration and reguritation

Summary: Globus patients Variable history No true dysphagia Young female No weight loss Associated anxiety

Summary: Pouch patients Older male/female REGURGITATION Gurgling swallow Recurrent chest infections Weight loss

Thankyou